Sinusitis and chronic progressive exercise-induced cough and dyspnea
We present the case of a 47-year-old man with exercise-induced dyspnea, cough, chest tightness, and recalcitrant chronic rhinosinusitis. Evaluation revealed IgE sensitization to grass, tree, and weed pollen, no evidence of obstruction on spirometry, and a negative methacholine challenge. Diagnostic considerations included allergic and nonallergic rhinitis, asthma, aspirin-exacerbated respiratory disease, vocal cord dysfunction, extra-esophageal manifestations of acid reflux, and vasculitits. Further evaluation with sinus imaging, laryngoscopy, ambulatory pharyngeal pH testing, upper endoscopy, and bronchoscopy led to a diagnosis. Key issues surrounding the diagnostic and therapeutic approaches to this patient's condition are reviewed.
Keywords: Asthma; chronic rhinosinusitis; cough; exercise; gastroesophageal reflux disease; laryngopharyngeal reflux; laryngopharyngitis; pharyngeal pH; vocal cord dysfunction
Document Type: Research Article
Affiliations: Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California, USA. [email protected]
Publication date: November 1, 2008
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